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A dual-process model of defense against conscious and unconscious death-related thoughts: an extension of terror management theory.

Distinct defensive processes are activated by conscious and nonconscious but accessible thoughts of death. Proximal defenses, which entail suppressing death-related thoughts or pushing the problem of death into the distant future by denying one's vulnerability, are rational, threat-focused, and activated when thoughts of death are in current focal attention. Distal terror management defenses, which entail maintaining self-esteem and faith in one's cultural worldview, function to control the potential for anxiety that results from knowing that death is inevitable. These defenses are experiential, are not related to the problem of death in any semantic or logical way, and are increasingly activated as the accessibility of death-related thoughts increases, up to the point at which such thoughts enter consciousness and proximal threat-focused defenses are initiated. Experimental evidence for this analysis is presented.

Behavior Therapy↗

The unconscious cost of good fortune: implicit and explicit self-esteem, positive life events, and health.

J. D. Brown and K. L. McGill (1989) found that positive life events were associated with better health only for people high in self-esteem. Among people low in self-esteem, positive life events were associated with poorer health. The authors of this study replicated this finding in a self-report survey of 61 male and 110 female college students. In addition, they showed that implicit self-esteem moderated the relation between positive life events and self-reported health in the same fashion as explicit self-esteem did. Whereas people high in implicit self-esteem reported being healthier when they experienced more positive life events, people low in implicit self-esteem reported being healthier when they experienced fewer positive life events. Moreover, the effects of implicit self-esteem were statistically independent of the effects of explicit self-esteem.

Adult↗

Science and society: death, unconsciousness and the brain.

The concept of death has evolved as technology has progressed. This has forced medicine and society to redefine its ancient cardiorespiratory centred diagnosis to a neurocentric diagnosis of death. The apparent consensus about the definition of death has not yet appeased all controversy. Ethical, moral and religious concerns continue to surface and include a prevailing malaise about possible expansions of the definition of death to encompass the vegetative state or about the feared bias of formulating criteria so as to facilitate organ transplantation.

Bioethical Issues↗

Prediction of functional outcomes after traumatic brain injury: a comparison of 2 measures of duration of unconsciousness.

OBJECTIVE: To compare the usefulness of time until motor localization occurs versus time until commands are followed in predicting outcome after traumatic brain injury (TBI). DESIGN: A retrospective analysis of data from a prospective cohort study of subjects with severe TBI. SETTING: Seventeen Traumatic Brain Injury Model System programs. PARTICIPANTS: A total of 496 subjects, recruited through the TBI Model System programs, with loss of consciousness greater than 1 day, with no late neurosurgical complications, and complete data for all measures. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time until Glasgow Coma Scale (GCS) motor score of 5 (time to motor localization) and time until GCS motor score of 6 (time until commands were followed) were abstracted from medical records. Functional outcomes were assessed at inpatient rehabilitation admission and discharge, along with acute and rehabilitation lengths of stay and charges. RESULTS: Time until commands were followed was a better predictor of all of the outcomes assessed than time until motor localization occurred. In multiple regression models, time until motor localization did not add significantly to the prediction provided by time until commands were followed. The predictive power of time to command following was superior even in the subgroup with poor language comprehension as measured by the Token Test. CONCLUSION: Despite the theoretical appeal of time to motor localization (eg, in persons with language comprehension problems), time to command following appears to be a more powerful predictor of outcome after severe brain injury.

Adult↗